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� MART28/2007%WED 07:20 AM ZEPHYRHILLS BUILDING FAX No. B(3-780-0021 P.001
<br /> a�a-.�so-aazo City ofZephyrhllls'Fine� •• • Fax-a��-�aaao2t ��:
<br /> permit Appltcation .__ .
<br /> Date Ftecelved ' '� •Phone Co�nlactiarPermit
<br /> OwnePe Name • Oxmer'c Phone Number � � �
<br /> Ownete Addrese O IJ g' � �X�-�"Z '
<br /> FeasimpleTlUeholderName � � ' ' � • ' TltleholderPhone Numbar �� � �
<br /> Kee Simpie'11Baholdc�Addre:a • ' ' ' � �
<br /> , '�JobAddres9 • . . . • • ��Lot#
<br /> 5ub Divislon Paroel# •
<br /> • o 610-Hazard Weete Storage-ANNUAL • � " �� FumlgaUon'Cent • , • �
<br /> . � Comm 5�haust f(iWien Hoodloucl: .' �• Hamrdous Meledai(fier II or RQ Feclllty)ANNUAL , '
<br /> a Contrvlled Bum � � Haod In9lalleUon �
<br /> � �mergency Ganerator<30 kw • . � LPINaturel Gas-InebilaUon � � � � ' �
<br /> • � ��mergency Ganeralor>3n kw •• � t-PMalur�l Gas-ANNUAL Sele
<br /> Rre Protecdon Iutsfntanence=ANNUAL. � Places vfAssemhly-AtdNuAL � • • •
<br /> . , gp�{�e� ��� p 1 �� . � ReofeAUons)Burtt , • • . .
<br /> • ' Fre Alarm �❑. ❑ [7'. � '� � 3pwk�ers : .• . ' ' ^ �
<br /> tuk�
<br /> Hood Cleaning � d� ❑ O� � � 3prin1slerSyatam Installadons ,• • , ��.�i�� Q�.` ,.�/
<br /> HoodSuppresslon . � {a D ❑ � , � Stendpipes(SpdnkierSys) � � +�W�� Y.7
<br /> ' � Fte A(anri If1etH11eUan . � . . � TofCh Roufingf�a�Ketlle; . , . T��Q�,�. � 1 I�S' I I 1
<br /> � �Flre Pumpa � , ' ' � � ' � � WBs�eTlia StorageANNUAt � . , (�
<br /> F1ro Worice ' • • • ' . . .
<br /> , Flemmable Apptira0on-ANNUAL • . • • � � • Valuetion�f PlojeCt . .
<br /> . Fuel Tanks , � ' '. ' ' '
<br /> . Q: Other: • ' ' ' • • •
<br /> canvaclor • •.� ' � • Campany ' .
<br /> Signawre �'�""� ' Repistared �Y V Fee Curreot X N •
<br /> Addrese � License#
<br /> �I,ECTRICIAN ' . ' � � Comperry •
<br /> Signatur� ' • Reg(sle�ed• Y J N • Fee CurtenG _,Y/N
<br /> Addrese � License# • ' �
<br /> PIUMBER • , • Company
<br /> Signalure � � � ' Reelatered Y/N Fee Current Y/N�
<br /> Addross ' Ucenea#• •^� •
<br /> MECHANICAL Company ' �
<br /> signawre ' Rcgistared Y/N Fae currcnl ,1(/N
<br /> � Address ' . •Liceqee#. �
<br /> OTHEI2 . . • Compeny .
<br /> signature � Ree�slered • Y/N �ea Current Y/N
<br /> Addrees � • ' • ' LtceneB#
<br /> Directions:
<br /> . FlII out appticaGon complately. • �
<br /> OWner&ConUAetof eign baok of appliealion,ttoladzed(Or,Copy of eigned contrnct WIIh olvnef) , . ,
<br /> " I(over S25�o,a Notice ot Commenca�nent ia requ�red.(Meche�ical worlc over$6000) • • • .
<br /> Suppfy tvro(2)ae�of drawinea�l�applicable documernatto� . • • , •
<br /> AlIoW 1D 14 daye far revlow aher aubmiUal date. Peccel#�•obWlned from P(operty TaX NoUce(htlpJ/eppreiaer.pascogov.com)
<br /> u�w�cun.,.....,i...�• -- ---••-•------� -
<br /> plumbinc�; signs, weAs� poois; air condition(ng, gas,•ot'ot�et'installatlo�5 not SpeCliiG�lly mCluaep m u�e apNnuauvu..r,
<br />� permlt issued shall be consfived to,be a ilcense to proceed with'the work and nof as authotlty to viol�te,cancel,alfer,or,
<br /> sef aside any provis;ons of fhe technical�codes, nor shall issuance of a permit prevent the�uilding.Officiai f�om thereafter .
<br /> requiring a cor�ection of.errors in plans,construction or violaftons af any codes. Every permit�(ssued shall becomB invalid
<br /> . unless the work authorized by such permlt is commenced wiihin slx months of permi�Issuance,or if work aufhorized by
<br />� the permft is suspended or abandoned far a periad of six•(6}months after the time the work ts commenced. An extension.
<br /> may be requestetl, in wrlting,fcom tha eullding Offlcial for a period not to exceed ninety(90) days and witl demonstrets-�
<br /> justi�fiabte cause for ftie extension. If work ceases fior niriety(so)consecuflve days,the�ob is cohsldered abandaned.
<br /> 'WARNING TO QWNER: 'YOUR �AIL'URE'T�•RECORb A'NOTICE'OF;C4MM�HCEMI�NT Mi�Y"'R�SUL'f 1N'YUUR "' '
<br /> pAYING TWIC�F�R IMPR01/EMENTSfiO YOUR.PROp�RTY. IP YOU INTENDTd OBTAlN�INANCII�1fa,CONSULT
<br /> �WITH OUR LENpER O 'AN A'f"1'ORNEY EFORE RECO QING YaUR ND'fICE OF COMMENCLIVIEN7'. '
<br /> FLORIDAJURAT(F.5,117.03) ' � • • • .
<br /> . -�'� �/ • �
<br /> ' OWN�R ORAGENT �: CONTR�►CTOR /-'-— �—� � � - ,
<br /> S d and swo o � , g� , e and e�i1nr�p(or aBl b�ro�m� e Ihis .
<br /> � • by �1�laV t . F�irj'�►�-�
<br /> o Is/are persanepy k o M q1e ar haslltave produced o I are perso�Uv kn a me or�l�sltlave produced
<br /> • __�,�� as Identification. . •as ideMUflCaUon.,
<br /> Notary Pu61ic Notary Public , -
<br /> .. .__. .._ 4�4�UQ11R I Cnmmissl0 ND. T � __ �� . .
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